Is it safe to simplify?

Sep 26, 2010

Hi Joe,

Following advice form my consultant, I have dropped the tenofovir component of my regimin, so that I am taking DRV(r) and 3TC instead of DRV(r)+ Truvada. Is this okay? I'm a little uncertain, but I think it should be okay given PI monotherapy success. If I do re-bound, will it select out M184V against 3TC initially? I don't want to screw my chances against future options (the quad, truvada/rilpivirne FDC, etc).
Thanks for your generous time.
Michael.
ps, baseline resistance revealed T215S.

Response from Dr. McGowan

Hello Michael

It is not clear from your question why tenofovir was stopped. Was it related to renal toxicity or other such concerns? You are right that there have been simplification studies wherein participants who were virologically suppressed on a combination regimen with a boosted PI simplified to solely a boosted PI regimen. Most of the participants continued to maintain virologic suppression. Having said that I am unaware of such studies with boosted darunavir. Moreover, if you did rebound the risk of selecting for the M184V mutation is high and this may compromise the "Quad" regimen since it would compromise the efficacy of FTC which is one of the 3 active drugs in Quad.

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